Analysis on the Implementation of Exclusive Breastfeeding in Working Area of Remu Primary Healthcare Center in Sorong, Papua Barat

Abstract

ASI eksklusif merupakan bagian penting dalam pemenuhan nutrisi bayi untuk mencapai pertumbuhan perkembangan optimal pada awal kehidupan dan masa pertumbuhan berikutnya. Kesepakatan Innocenti di Roma tahun 1990 mengamanatkan pencapaian ASI eksklusif 80%, sehingga target Standar Pelayanan Minimal (SPM) tahun  2003 di Indonesia ditetapkan 80%. Data SDKI tahun 1994 menunjukkan ibu-ibu  memberikan ASI eksklusif baru mencapai 47%.
Metode penelitian adalah kualitatif. Subjek penelitian adalah tenaga Gizi dan Bidan KIA Puskesmas Remu. Sebagai Triangulasi adalah Pimpinan Puskesmas, Kepala Seksi Kesehatan Ibu dan Anak Dinas Kesehatan Kota Sorong serta  ibu  yang memiliki bayi usia kurang dari 6 bulan. Pengumpulan data dilakukan melalui wawancara mendalam dan studi dokumentasi  .
    Hasil penelitian menunjukkan bahwa pelaksanaan program ASI ekslusif di Puskesmas Remu belum berjalan baik. Petunjuk teknis atau SOP tesedia di Puskesmas, namun dalam pelaksanaan program belum sesuai. Pelaksanaan program yang sering dilakukan berupa penyuluhan saat posyandu, ANC dan persalinan. Sosialisasi aktif dari puskesmas oleh bidan, dari bagian gizi di Puskesmas belum dilaksanakan. Dari DKK tidak mempunyai jadwal tetap. Sosialisasi dipaketkan saat ANC, posyandu, minilokakarya, saat evaluasi program dan menempelkan pamflet di Puskesmas. Sosialisasi hanya berupa penyuluhan tanpa dilengakapi alat peraga yang memadai. Ketersediaan dan kualitas tenaga di Puskesmas masih kurang,  belum mendapat pelatihan sehingga dibantu perawat yang belum dilatih. Dana yang tersedia langsung diserahkan ke ahli gizi Puskesmas untuk dikelola. Dana tersendiri untuk pelaksanaan program ASI ekslusif belum ada. Alat peraga kurang, hanya leaflet, namun sudah tidak layak pakai. Kendaraan yang tersedia hanya motor. Jumlah peralatan belum mencukupi. Klinik khusus laktasi belum tersedia. Watak atau sikap petugas yakni respon, komitmen dan pemahaman dalam program ASI ekslusif di Puskesmas Remu masih baik.   
       Pelaksanaan program ASI ekslusif dapat berjalan dengan baik dengan menjalankan SOP/petunjuk teknis oleh seluruh pelaksana program, menyiapkan tenaga gizi di tiap Puskesmas, meningkatkan sosialisasi, membuat job description dengan jelas, penyediaan reward dan insentif sesuai beban kerja dan kompetensi, keuangan tersendiri untuk program ASI ekslusif, monitoring dan koordinasi pelaksanaan program ASI ekslusif dan pendokumentasian kegiatan secara benar

Exclusive breastfeeding was an important part in fulfilling infant nutrition to gain optimum growth and development in the early live and in the next growth period. Innocenti agreement in Rome in 1990 mandated that the exclusive breastfeeding coverage was 80%. Therefore, the minimum service standard (SPM) coverage for exclusive breastfeeding in 2003 for Indonesia was established to be 80%. Data of SDKI in 1994 indicated that exclusive breastfeeding coverage was still 47%.

This was a qualitative study. Study subjects were nutrition field workers and maternal and child health (KIA) midwives of Remu primary healthcare centre. Triangulation respondents were the head of primary healthcare centre, head of maternal and child health section of Sorong city health office, and mothers of infants less than 6 months. Data were collected by conducting in-depth interview and documentation study.

Results of the study showed that the implementation of exclusive breastfeeding program in Remu primary healthcare center was still inadequate. Standard operating procedure was provided in the primary healthcare center, but the program was not implemented according to the standard. Programs frequently implemented were giving education in the posyandu, ANC and delivery process. Active socialization by midwives and nutrition section workers from primary healthcare center had not done yet. District health office did not have routine schedule. Socialization was attached in the ANC, posyandu, mini workshops, and evaluation sessions. In addition, it was also done by putting pamphlets in the primary healthcare center. Socialization was only in the form of giving education without sufficient visual aids. The availability and quality of human resource in the primary healthcare was still insufficient; they had not been trained, and they were accompanied by untrained nurses. The available funding was given directly to the primary healthcare nutritionist to manage it. No special funding was available for exclusive breastfeeding program. Visual aids or models were insufficient; only leaflets with unfeasible condition were used. The available transportation vehicle was only motor cycle. The number of instruments was insufficient. No lactation clinic was available. Character and attitude of the workers such as giving response, commitment and understanding on the exclusive breastfeeding in Remu primary healthcare center were good.

The implementation of exclusive breastfeeding program will be good by implementing the standard operating procedure or technical guidance, assigning nutritional field workers in every primary healthcare centre, improving socialization, formulating clear job description, providing rewards and incentive according to workload and competence, separating finance for exclusive breastfeeding program, monitoring and coordinating the implementation of exclusive breastfeeding program, and having an adequate documentation of the activities.